HYDROCEPHALUS WITH VENTRICULOPERITONEAL SHUNTS IN INFANTS: OUR EXPERIENCES AND CLINICAL  OUTCOMES

Hristina Mandzukovska; Aspazija Sofijanova; Tamara Voinovska; Silvana Naunova Timovska; Mica Kimovska Hristov; Besim Vejseli; Olivera Jordanova; Spasija Neskova Jankovic

Hristina Mandzukovska University Children`s Hospital - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Aspazija Sofijanova University Children`s Hospital - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Tamara Voinovska
Silvana Naunova Timovska University Children`s Hospital - Skopje, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Mica Kimovska Hristov University Children`s Hospital - Skopje, North Macedonia
Besim Vejseli University Children`s Hospital - Skopje, North Macedonia
Olivera Jordanova University Children`s Hospital - Skopje, North Macedonia
Spasija Neskova Jankovic University Children`s Hospital - Skopje, North Macedonia

Abstract

Hydrocephalus is a condition resulting from disorder in absorption and circulation of the cerebrospinal fluid (CSF). It leads to progressive ventricular dilatation and need of ventriculoperitoneal shunt (VP) placement. The aim of our study is to present our experience on neonates with hydrocephalus, ventriculoperitoneal shunt placement, and early postoperative follow up. A retrospective study on neonates with hydrocephalus borned between January 2019 -January 2022 with ventriculoperitoneal shunt placement conducted at University Clinic for Neurosurgery in Skopje, Macedonia was reviewed. Demographical and clinical characteristics, complications and the need for ventriculoperitoneal shunt were documented. 23 infants with hydrocephalus 14 (60,8 %) were preterm (median birth weight 2120g; mean gestational age 33.1weeks), 9 (39.1%) infants were term neonates (mean birth weight 3600g; mean gestational age 38.4 weeks). The etiology of hydrocephalus were; congenital hydrocephalus in 5 infants (21,7%), prematurity in 6 infants ( 26,08%), spina bifida in 2 infants (8.7%), systemic infection in 4 infants ( 17,3%), and intraventricular haemorrage in 6 infants (26,08%).Ventriculoperitoneal shunt was placed to all 23 infants, at mean age of 33,5 (30-43) days. Postoperative complications as a result of ventriculoperitoneal shunt placement were; ventriculitis was manifested at 3 preterm (13%) infants, 2 of them (8,6%) died. Five term infants (21,7%) with postoperative seizures had need of VP replacement; 2 infants (8,6%) died. 19 infants (82,6%) were discharged and transfed to neonatology department. Ventriculoperitoneal shunt placement is the treatment of choice for neonates with hydrocephalus, although postoperative complications in preterm neonates increase the percent of morbility and hymortality.

Ðšeywords:Hydrocephalus,ventriculoperitoneal shunt, neonates, postoperative complications.

References

1. Isik U, Ozek MM. Clinical Findings of Children with Hydrocephalus. Pediatric Hydrocephalus. 2018; 1-19.
2. Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. European journal of medical genetics. 2014; 57: 359-368.
3. Munch TN, Rostgaard K, Rasmussen ML,Wohlfahrt J, Juhler M, Melbye M, Familial aggregation of congenital hydrocephalus in a nationwide cohort. Brain : a journal of neurology. 2012.
4. Rekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal fluid research. 2008; 5: 2.
5. Aykanat Ã–. The Analysis of Syrian Refugee Patients Treated With the Diagnose of Hydrocephalus: The Study of 28 Cases. Kafkas J Med Sci. 2017; 7: 67-70.
6. Bondurant CP, Jimenez DF: Epidemiology of cerebrospinal fluid shunting Pediatr Neurosurg. 1995, 23:254- 259. 10.1159/000120968.
7. Pan P: Outcome analysis of ventriculoperitoneal shunt surgery in pediatric hydrocephalus. J Pediatr. Neurosci. 2018, 13:176-181. 10.4103%2Fjpn.JPN_29_18.
8. Reddy GK, Bollam P, Caldito G: Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014, 81:404-410. 10.1016/j.wneu.2013.01.096.
9. Reddy GK, Bollam P, Caldito G: Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg. 2012, 78:155-163.
10. Dincer A, Ozek MM. Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst 2011;27:1543â€“62.
11. Bilginer B, Cataltepe O. Hydrocephalus: Classification, pathophysiology and treatment. In; KorfalÄ± E, Zileli M. Basic Neurosurgery, 1st ed. Ankara: Tr Neurosurg Ass 2010;1899â€“910.
12. Eid S, Iwanaga J, Oskouian RJ, et al. Ventriculosubgaleal shuntingâ€”a comprehensive review and over two-decade surgical experience. Child's Nervous System. 2018: 1-4.
13. Kulkarni AV, Riva-Cambrin J, Rozzelle CJ, et al. Endoscopic third ventriculostomy and choroid plexus cauterization in infant hydrocephalus: a prospective study by the Hydrocephalus Clinical Research Network. Journal of Neurosurgery: Pediatrics. 2018; 21: 214-23.
14. Fountain DM, Chari A, Allen D, et al. Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis. Child's Nervous System. 2016; 32: 259-267.
15. G. Kesava Reddy, Papireddy Bollam, Gloria Caldito. Ventriculoperitoneal Shunt Surgery and the Risk of Shunt Infection in Patients with Hydrocephalus: Long-Term Single Institution Experience; World Neurosurgery 2012, 78:155-163.
16. Kingsly EN, Kanumba ES, Lemeri L, Shabbhay Z: Outcome of ventriculo-peritoneal shunts inserted at the parieto-occipital area: a one-year experience at muhimbili orthopaedic institute, Dar es Salaam. Inter J Neurosurg. 2012, 1:117-121.
17. Braga MHV, Carvalho GTCD, BrandÃ£o RACS, Lima FBFD, Costa BS: Early shunt complications in 46 children with hydrocephalus. Arq Neuropsiquiatr. 2009, 67:273-277. 10.1590/S0004-282X2009000200019.
18. Davis SE, Levy ML, McComb JG, Masri-Lavine L: Does age or other factors influence the incidence of ventriculoperitoneal shunt infections?. Pediatr Neurosurg. 1999, 30:253-257. 10.1159/000028806.
19. Lee JK, Seok JY, Lee JH, et al.: Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci. 2012, 27:1563-1568. 10.3346/jkms.2012.27.12.1563
20. Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H: The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg. 2017, 98:654-658. 10.1016/j.wneu.2016.10.136.
21. Czosnyka M, Czosnyka ZH, Whitfield PC (2004) Cerebrospinal fluid dynamics. In: Cinalli C, Maixner WJ, Sainte-Rose C (eds) Pediatric hydrocephalus. Springer, Milan, pp 47â€“63.
22. Woo PY, Wong HT, Pu JK, et al.: Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors. Hong Kong Med J. 2016, 22:410-419.
23. Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J: Ventriculoperitoneal shunt complications needing shunt revision in children: a review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012, 9:32-39. 10.4103/0189-6725.93300.
24. Giuseppe Cinalli & Pietro Spennato & Anna Nastro & Ferdinando Aliberti & Vincenzo Trischitta & Claudio Ruggiero & Giuseppe Mirone & Emilio Cianciull. Hydrocephalus in aqueductal stenosis. Childs Nerv Syst (2011) 27:1621â€“1642 DOI 10.1007/s00381-011-1546-2.
25. Aykanat Ã–. The Analysis of Syrian Refugee Patients Treated With the Diagnose of Hydrocephalus: The Study of 28 Cases. Kafkas J Med Sci. 2017; 7: 67-70.
26. Preuss M, Kutscher A, Wachowiak R, et al. Adult long-term outcome of patients after congenital hydrocephalus shunt therapy. Child's Nervous System. 2015; 31: 49-56.
27. Matthias Gmeiner, Helga Wagner, Christoph Zacherl Petra Polanski , Christian Auer, Willem J R van Ouwerkerk, Kurt Holl, Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study; Childs. Nevr.Syst.2017 Jan;33(1):101-109. doi: 10.1007/s00381-016-3268-y.